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1558611483
KYANA WALLACE
NEW YORK, NY
NPI
1558611483
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: NY 051928-1)
Enumeration Date
2012-09-18
Last Update Date
2012-09-20
Business Address
Ms. KYANA WALLACE PA-C
75 BROAD ST
NEW YORK, NY 10004-2415
Phone number: 877-456-0369
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Mailing Address
Ms. KYANA WALLACE PA-C
20 COOLIDGE PL
FREEPORT, NY 11520-2543
Phone number: 516-477-8973
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